The 1937 club started this week, hosted by Karen at Kaggsy’s bookish ramblings and Simon from Stuck in a book. I very much like books from the 1930s so I was delighted when this year was chosen, it was the year my dad was born. I had a couple of books I could have chosen to read but the first one I settled on was one I first had to buy for my Kindle.
The Citadel by A J Cronin is a book I have been dimly aware of for many years, at least I think I can remember seeing some old paperbacks of his novels on my parents bookshelves back in the day. The tagline on the cover of this Bello books Kindle version – ‘the classic novel that inspired the NHS’ is quite the claim, how true that is I don’t know, although Wikipedia seems to suggest the same and it’s conceivable that the politicians involved in the push for the establishment of the NHS might have read it. A J Cronin was himself a doctor, and he used his experiences to write his best selling novels. Funnily enough a character in my current read, also for the 1937 club, is struggling to read another Cronin novel, The Stars Look Down. The Citadel was a marvellous read, a real saga – and enormously compelling.
The novel opens in 1924 as newly qualified Scottish doctor Andrew Manson arrives in a small Welsh mining town to take up a position as assistant doctor with a Dr Page. This fictitious town is realistically portrayed by Cronin, who himself had worked in Welsh mining towns. Andrew arrives to discover Dr Page is severely disabled by a stroke, cared for by his sister who runs the house and insists her brother will be up and about soon. Andrew realises that isn’t the case, but he gets down to work, and all the work of Dr Page’s practice falls to him. It’s a massive learning curve – and Andrew is naturally nervous of making a mistake with his first patients.
“All at once, with a quick pang, he was conscious of his nervousness, his inexperience, his complete unpreparedness, for such a task.”
There is a lot of poverty in the town, many miners suffering from lung diseases and a huge amount for Andrew still to learn. Another doctor in the town is Philip Denny, a hard drinking cynic, who had previously worked as a surgeon before falling foul of colleagues and ending up as an assistant doctor like Andrew. It is with Dr Denny that Andrew conspires to blow up a sewer in order to force the council to rebuild it – as nobody will listen to their concerns of its effects on public health.
Andrew begins to see how the system really doesn’t help the people it should. He is keen, hardworking and idealistic, he won’t just prescribe unnecessary medicine to patients (which costs them money) even when they think they want it, and he won’t just keep signing men off work when they are capable of returning to their jobs. Some doctors lack the competence they should have – others are too concerned with making money from private patients.
“…But Bramwell was not inexperienced and because of that his ignorance was inexcusable. Unconsciously Andrew’s thoughts returned to Denny who never failed in his derision towards this profession to which they belonged. Denny at first had aggravated him intensely by his weary contention that all over Britain there were thousands of incompetent doctors distinguished for nothing but their sheer stupidity and an acquired capacity for bluffing their patients.”
Andrew is outspoken and principled – and there are those who don’t like that. Everywhere he goes he makes both friends and enemies. Having fallen foul of Dr Page’s rather unpleasant and difficult sister, Andrew decides to leave and takes a position in another mining town in South Wales. His new job is as an assistant in a miners’ medical aid scheme and it comes with a house. The committee wants a married man, which delights Andrew as it means he can now marry the woman he loves, Christine, a young school teacher.
Andrew and Christine are happy, they don’t have much money but Andrew is busy and continually excited by his work. He enlists the help of Christine to carry out his research into lung disorders. He studies for his MRCP, to make him a more attractive candidate in the future and publishes a paper about his research.
Andrew is ambitious – and soon London beckons – and with it the lure of private practice, wealthy patients. Andrew has his head turned – Christine is dismayed to see his ideals falter – their lives begin to change.
What Cronin does brilliantly is to show the huge inequalities and corruption that existed within the medical profession. There are many ups and downs for Andrew and his wife over the course of a few short years, but it makes for a brilliant immersive read.
Really interesting to read your review Ali, especially as I know a GP who recently read this as part of his ongoing training. I was thinking of reading it myself. However, he was very disappointed with the book, commenting that the characters were not well developed, themes were not explored very thoughtfully and it read much more like a contemporary pot boiler than a work of classic literature. John Berger’s – A Fortunate Man (memoir not fiction), which he read as part of the same project, he found much more satisfying.
I’m sorry your friend was disappointed in this, perhaps if I had read other similar books I might have judged it differently. It’s not a literary novel certainly or a character driven piece, it’s much more plot driven than I usually like.
I have loved this book ever since I first read it as a teenager!
Good to hear you enjoyed this one too.
Sounds excellent–like you I’ve been vaguely aware of this (though not quite what it was about) and keep meaning to look up a copy but haven’t yet done so. Looks like I really should.
I would be interested in your take on it, I now realise it seems to divide people.
I’ll try and pick it up soon; my mother had read lots of Cronin years ago and remembers liking them.
This sounds such a compelling read Ali, absolutely fascinating. I’d not heard of it but I’ll look out for it now. I’m wondering if my library might have a copy…
So fascinating yes, I especially liked the early section set in Wales. Highlighting a very different time for medicine.
So glad you enjoyed this one Ali – I’ve been aware of Cronin for a while although not read him. Although he may appear in a post on my blog this week, with perhaps a less favourable view… 😳
Yes, well I saw Mr K’s review of course. Perhaps it’s a book that divides readers. I’m glad I read it.
I’ve never found any hard evidence that this book did inspire the National Health Service. However, it’s not beyond the bounds of possibility because the town of “Aberalaw” (the second one Mason practices in) is actually based on the town of Tredegar whose MP was Aneurin Bevan. So if Bevan read the book, its description of a subscription based health service could well have given him the germ of the idea for the NHS.
The book has its flaws – I thought it was too long and too much given to dramatic episodes. But enjoyed it because Aberalaw (ie, Tredegar) is actually where I was born…
Yes, I wasn’t convinced by the claim so I had a quick look on Wikipedia. I don’t know if there is really clear evidence that it played any part, but it’s an interesting idea that Bevan et al may have read it during those years.
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I remember reading The Citadel when I was a teenager, probably around the same time I read How Green Was My Valley. Both great books, opened my eyes to a time and place I didn’t know anything about.
I haven’t read How Green Was my Valley but it a book I remember being aware of. Liz read it a while ago reminding me about it. I’m sure that’s a novel I would also like.
A great review of what sounds like a fascinating book! In some respects, it could be seen as piece of social history (despite its classification as fiction) as it was inspired by Cronin’s own experiences. I love books like this, especially if they’re set in the interwar years.
It’s always the social history that interests me in books like this. It’s not a literary or character driven piece, but I found it immensely readable.
One of my favorite writers, I have read all his books. The Citadel is one of his best.
That’s great to hear, I shall look up some of his others.
I loved this one – such a good storyteller, as well as having something important to say. The reprint I read put that thing about it inspiring the NHS, but maybe that just became so often repeated that everyone believed it, without evidence!
Ha, yes I did wonder if that story hadn’t just become apocryphal. So glad you enjoyed this one too. I haven’t read anything else by him but I will explore his other work.
This sounds brilliant – a bit like one of Francis Brett Young’s maybe?
It did remind me a little of My Brother Jonathan by FBY, which was about a Dr pre NHS, I think there is another by him too that I haven’t read.
I seem to recall watching a mini-series with my mother long ago, although I have never read this – sort of an All Things Great and Small for doctors.
Do I also remember Harriet Vane trying to read the author’s other book? Wouldn’t you be annoyed if someone mentioned your book in this context? I don’t think it was an inside joke; it does not appear his path and Sayers’ really crossed.
Yes, lol. It is Peter Wimsey’s mother who is struggling to read an A J Cronin novel, The Stars Look Down, I think.
I like reading about mining towns and the culture in/around them. This isn’t a book I know much about, but from what you’ve said, I think I’d enjoy the same parts of it that you did!
Yes, I enjoyed the Welsh section the most. It was a good compelling read altogether though.